TY - JOUR
T1 - Electromyographic biofeedback-driven gaming to alter calf muscle activation during gait in children with spastic cerebral palsy
AU - Flux, Eline
AU - Bar-On, Lynn
AU - Buizer, Annemieke I.
AU - Harlaar, Jaap
AU - van der Krogt, Marjolein M.
N1 - Funding Information: The authors would like to thank Babette Mooijekind, Lara Visch, Catherine Hooper, Esther Kret, Olaf Atteveld, and in particular Wiek Dirks, for their help in data collection, and Sarah Dekker and Laura Oudenhoven for their help in patient recruitment. This work was financially supported by the Dutch Research Counsil (grant numbers TTW-14903 and NWO-016.186.144 ). Publisher Copyright: © 2023 The Authors
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background: Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. Research question: Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? Methods: Eighteen children (6–17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. Results: Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). Significance: This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
AB - Background: Children with cerebral palsy often show deviating calf muscle activation patterns during gait, with excess activation during early stance and insufficient activation during push-off. Research question: Can children with cerebral palsy improve their calf muscle activation patterns during gait using one session of biofeedback-driven gaming? Methods: Eighteen children (6–17 y) with spastic cerebral palsy received implicit game-based biofeedback on electromyographic activity of the calf muscle (soleus or gastrocnemius medialis) while walking on a treadmill during one session. Biofeedback alternately aimed to reduce early stance activity, increase push-off activity, and both combined. Early stance and push-off activity and the double-bump-index (early stance divided by push-off activity) were determined during baseline and walking with feedback. Changes were assessed at group level using repeated measures ANOVA with simple contrast or Friedman test with post-hoc Wilcoxon signed rank test, as well as individually using independent t-tests or Wilcoxon rank sum tests. Perceived competence and interest-enjoyment were assessed through a questionnaire. Results: Children successfully decreased their electromyographic activity during early stance feedback trials (relative decrease of 6.8 ± 12.2 %, P = 0.025), with a trend during the combined feedback trials (6.5 ± 13.9 %, P = 0.055), and increased their electromyographic activity during push-off feedback trials (8.1 ± 15.8 %, P = 0.038). Individual improvements were seen in twelve of eighteen participants. All children experienced high levels of interest-enjoyment (8.4/10) and perceived competence (8.1/10). Significance: This exploratory study suggests that children with cerebral palsy can achieve small within-session improvements of their calf muscle activation pattern when provided with implicit biofeedback-driven gaming in an enjoyable manner. Follow-up gait training studies can incorporate this method to assess retention and long-term functional benefits of electromyographic biofeedback-driven gaming.
KW - Biofeedback
KW - Cerebral palsy
KW - Electromyography
KW - Experimental games
KW - Gait training
UR - http://www.scopus.com/inward/record.url?scp=85149317843&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.gaitpost.2023.02.012
DO - https://doi.org/10.1016/j.gaitpost.2023.02.012
M3 - Article
C2 - 36870265
SN - 0966-6362
VL - 102
SP - 10
EP - 17
JO - Gait and Posture
JF - Gait and Posture
ER -